American journal of disaster medicine
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Biomedical ethics decisions are often made after reflection, deliberation, and after a process of communication, reveal the values and interests of the patient or the patient's family. However, acute and rapid changes in the patient, the very public view of the care provided, and a need for rapid decision making by paramedics in a prehospital setting make protracted deliberation and reflection a practical impossibility. ⋯ These choices transcend the technical judgment and professional skills necessary for provision of emergency care in prehospital settings. This article identifies, describes, and organizes a number of central values of professional paramedics and discusses how values may be considered by paramedics when resolving conflicting values.
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Randomized Controlled Trial
Does the simple triage and rapid treatment method appropriately triage patients based on trauma injury severity score?
To correlate the simple triage and rapid treatment (START) colors to trauma injury severity scores (ISS). ⋯ The START method is a simple technique used to triage quickly a large number of patients. Healthcare providers can undergo just-in-time training to learn this technique and use it effectively. The START colors also imply a correlation with the trauma ISS, with higher ISS more likely to be triaged "red" or "black."
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Randomized Controlled Trial
Training medical staff for pediatric disaster victims: a comparison of different teaching methods.
The goal of this study was to assess the effectiveness of the different types of healthcare worker training in pediatric disaster medicine knowledge over time and to analyze the effects of training type on healthcare workers' attitude toward pediatric disaster medicine. ⋯ Didactic lecture and tabletop exercises both increase healthcare worker's knowledge of pediatric disaster medical topics. This knowledge seems to be retained for at least 6 months postintervention. The addition of the tabletop exercise to a standard didactic lecture may increase a learner's sense of knowledge and comfort with disaster topics, which may in turn lead to increased staff participation in the event of an actual disaster.
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There is a need to develop tools for the rapid diagnosis and treatment of fractures and intraosseous pathology in remote and austere environments. Several emergency and orthopedic studies have demonstrated ultrasound to be a reliable tool in diagnosing these conditions in both adult and pediatric patients. The purpose of this pilot study is to assess the ability of the ultrasound to assess in "real-time" the success of fracture reduction in adult patients in the emergency department (ED), in comparison with the accepted standard, plain film radiography, for the purposes of future application in austere environments. ⋯ In this pilot study, emergency physicians demonstrated the use of ultrasound in place of traditional radiography to either confirm adequate reduction or assess the need for further manipulation. Our pilot study suggests that ultrasound has a possible future role in fracture reduction management in both the ED as well as "austere"prehospital locations.
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Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism. These attacks are virtually always directed against the untrained and unsuspecting civilian population. ⋯ It needs to be realized that physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply and for this reason, emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision-making.